Top Five ICD-10 Readiness Questions To Ask Your Payers

Aug 1, 2013 | Uncategorized

icd-10When all is said and done, ICD-10 is about the money. On October 1, 2014, providers just want to know if they’ll be getting paid for their services. The question isn’t as easy to answer as many people think, and there are plenty of jitters when it comes to how payers will handle ICD-10 codes, if they will be processed in a timely manner – and if the new version of their claims will even go through. Unfortunately, it’s impossible to predict whether the industry will be ready on time, and if the transition will be a success. But even without a crystal ball, you can get a jump on your preparations by asking your payers this list of important questions about their ICD-10 plans.n

Who is my dedicated contact person?

nJust like with vendors, many health plans are big, bureaucratic organizations, and they have just as much on their plate as you do. They will have hundreds or thousands of physicians asking them the same questions about ICD-10, and you don’t want to get lost in the shuffle. Make sure that you have a dedicated point-person to talk to, and that he or she is capable of giving you timely and meaningful answers.n

icd-10Are you going to be conducting external testing?

nWith all the stress that CMS has put on testing, testing, testing, this is still a very important question to ask, because the answer might very well be “no”. Medicare’s official position at the moment is that CMS contractors will not be conducting full external testing with business partners, leaving the vast majority of providers unsure if their claims can be accepted by the biggest payer in the industry. And since many major health plans follow Medicare’s lead, there is widespread concern among providers that they will be left guessing ahead of the implementation date.n

When will you be ready to do so?

nIf some or all of your payers will be conducting testing, be sure to ask when they’re going to be ready to start, how many claims they will want to accept from you, and what kind of feedback you’ll be getting on the quality of your ICD-10 coding. Ensuring that both you and your payer are HIPAA Version 5010 compliant is one of the critical aspects of ICD-10 that hasn’t been stressed enough. ICD-10 is entirely based on 5010, and if you’re one of the providers who haven’t switched over yet, you’re not going to be able to send and receive billing information at all.nnTesting isn’t just a technical necessity. It will also help you figure out if unspecified codes are acceptable to any of your business partners, and if your documentation and medical coders are up to snuff. This extra practice for your staff can help mitigate productivity losses after go-live, and make them more comfortable with the idea that they’re on the right track.n

Will you be dual processing? When will you start?

nMany payers are looking to dual processing – accepting both ICD-9 and ICD-10 codes for a period of time to ease the transition and allow comparisons – as the best way to move forward and keep revenue flowing appropriately. It’s an enormous opportunity for providers, as well: your coders and physicians will have extra time to practice their documentation improvement strategies and ICD-10 coding while seeing exactly what the world after October 1 will look like.n


nWhile CMS has not indicated that dual coding will be accepted for some transition period after October 1, ask your payers if they are planning to take this step, and when they will start so you have the most time to maximize the benefits of side-by-side coding.n

What happens if things go wrong?

nYour payers might not have an answer for you. No one really knows what’s going to happen on October 1, and with a year left on the clock, anything is possible. Thorough, meaningful communication with all your business partners is the best way to ensure that if something does go wrong, you have a contingency plan in place to mitigate the fallout. Both payers and providers stake their entire businesses on making sure that claims are paid quickly, smoothly, and to the fullest extent, so it’s in everyone’s best interests to work together during the crucial time.n

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nSource:; Jennifer Bresnick; July 29, 2013